Chapter 5 - Modeling the End of AIDS

Summary

This chapter interrogates assumptions behind the models used both in cost-effectiveness analysis, and to set global targets. The models neglected to address how human rights realities, such as health sector discrimination and legal barriers, might undermine the optimistic scenarios the models predicted would result from scale-up of testing and treatment. The lack of quantitative research showing that addressing human rights would have a measurable impact on health, and that such work was cost-effective, meant that it was easy to exclude these and similarly unquantified considerations from biomedical scael-up. Thus in many countries, the work of addressing stigma, discrimination, criminalization, and gender inequality, while frequently cited as rhetorically important, is in practice an afterthought in planning, financing and implementing the HIV response. The second part of the chapter returns to Grenada to observe community activists and health officials wrestling with the challenges of quantification, as they debate which questions to ask in the study. While the global mathematical models aimed at simplicity in order to drive decision-makers to prioritize funding HIV programs, the CVC study wrestled with the problem of how best to capture local complexities and protect the fragile thread of trust they were beginning to establish with hidden communities.